Tuesday, July 30, 2013

Complication after complication

I went for a walk with a few of the short term volunteers up the
mountain behind the hospital. A good chance to get away from the cares of the hospital. Nope, nevermind. Way up on top of the mountain path, I got called
by the midwife about a patient who I had seen earlier in the morning on rounds.
She was complicated, her water had been broken for seven days before she came
to the hospital, thus she had begun to have a severe infection in the uterus. I had
been treating her with antibiotics. As well, she had preeclampsia, a problem of
high blood pressure which can become very dangerous, eventually lead to seizures. I gave the nurse
some orders, telling her to deliver the baby. The mom wasn’t having
contractions any more, but the baby was sitting there ready to come. A few
minutes afterward, my phone rang again. The midwife hadn’t followed my
instructions, in fact she had gone home. The next shift had just arrived, and
there was only confusion. I could tell that things were going from bad to
worse. The preeclampsia was getting worse, the fetal status was getting worse, the communication was getting worse. I tried again to make them understand that they needed to proceed with
delivery. I began realizing that the chance for a poor outcome was going up
exponentially as I heard the panic in the voice on the other line. I made sure both mom and
baby were stable for the moment, and told them to just monitor them and wait. I
would be back within 45 minutes. I told the hiking group that I would have to leave
them, and headed back. A few minutes later, I saw a rare moped riding along the
slippery, rocky mountain trail. It seemed like a God-send. Only rarely do they they
ride so far up there to take someone home who lives out in the bush, since the
path is terrible. I waved him down. It took a minute to bargain him down to a
reasonable price, but then I hopped on the back and off we.

Bumpety, bumpety, bump over the rocks, slipping into the ruts of
the path we rode (or slid in many places) down the mountain. The waft of
alcohol occasionally passed from the driver’s breath to where I could smell it
even riding behind. I held on tightly to the bar behind my seat. I came up with
a theoretical plan, that if the bike should begin to fall due to the rough
terrain or the inebriated driver, that instead of trying to put my foot down
and catch us (as seemed natural), I would spread my feet and catch myself, to
let the motorcycle pass in front of me before it fell, leaving me behind and
safe. Sometimes I make a “just in case plan”, thankfully, I rarely end up using
it. Too many of those prior motorcycle
drivers (and riders) have passed through the orthopedic ward and now hop around
with crutches on their one leg.

We made it back in a fraction of the time that it would have
usually taken me on foot. I walked into the maternity ward and checked the
patient. The mother was lethargic from the medicine that she was on to prevent
seizures. We lifted her onto the delivery table. Then I grabbed the gloves and
checked everything out. Things were not as had been reported, and they were
even a bit worse. I described to the mother that I needed her to push with all
of her heart. I applied a vacuum device to help pull the baby out. A few
minutes later, out came a floppy and tired baby, barely able to breathe. The
resuscitation began on the other side of the room. Meanwhile, I knew that the
mother had many risk factors that could cause her to bleed after delivery. And
she certainly did. I was almost up to my elbow inside her trying to arrest the
bleeding. As I worked deep within her, it felt as if she was on fire with heat
from the infection inside her womb. I glanced at the baby, knowing that it too
was doing poorly because of being exposed to the infection for too long. The
bleeding continued as I returned my eyes to focus on the mother. Medications
were coming, but seemed to take so long to get drawn up and unwrapped and such.
Finally, the bleeding slowed and I knew that we were going to be okay.

After I wrote a note in the chart, I headed back to the house. My
hiking shoes had blood splattered all on them. My arms were tired. My passions
were tired. So many problems, both with the patient and with the management of
the patient. Another close call, too close. Another sick mom and sick baby.
There are so many women and babies at risk, and so many opportunities for poor
outcomes. But almost each time, earlier recognition and intervention could give
a better outcome. I sometimes blame the staff. I sometimes get so frustrated. I
know that it could be so much better. I am praying that God will engage the
hearts of the staff to desire to learn more and care deeply. But I am thanking
Him that in spite of our failures and lack, He often provides for us anyways. There were so many
other routes that could have ended their story. One complication seemed to pile on the next. But tomorrow, a healthy mom and baby are going home together. Thankfully, this is the
story that they get to own.